MEDICARE: SUE A LEATHERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35044589L	OH
2	207Q00000X	Family Medicine Physician	35.044589	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043217839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE A LEATHERMAN M.D.

Provider Business Mailing Address
First Line	:	882 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-235-5555
Fax Number	:	614-338-6805

Provider Business Practice Location Address
First Line	:	2365 INNIS RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224
Country	:	US
Telephone Number	:	614-416-4325
Fax Number	:	614-416-4320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/06/2011

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Directions to “ SUE A LEATHERMAN M.D.” Practice Location

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